The VA should begin gender-affirming surgery for trans veterans

Twelve years ago this week, “Don’t Ask, Don’t Tell,” the discriminatory military policy that barred lesbian, gay and bisexual people from serving openly in the U.S. Armed Forces, ended. Between 1994 and 2011, while Don’t Ask, Don’t Tell was in effect, the military kicked me and an estimated 14,000 of my peers out — not for our merits, but simply because of who we were as people. 

While ending Don’t Ask, Don’t Tell enabled military service for lesbian, gay and bisexual people, transgender people were still de facto banned under a McCarthy-era executive order that tasked federal agencies with investigating their employees who pose “security threats.”  

Despite serving our country with honor, many of these transgender veterans are denied the comprehensive gender-affirming care they need because transition surgeries are not covered by Veterans Affairs health insurance. All veterans deserve the full suite of medically necessary health care options, and the exclusion of gender-affirming surgery is a critical omission in the health package that eligible veterans are entitled to after they complete their military service.  

Despite being able to serve openly only since 2016, there are an estimated 134,000 transgender veterans in the U.S. Many have chosen to live in Maryland, where I serve as secretary of Veterans Affairs and am tasked with supporting veterans and their families with securing the benefits they’ve earned.  

Transgender veterans have been waiting for this reform, which was announced by Veterans Affairs Secretary Denis McDonough more than two years ago. Earlier this year, the VA said it had no timeline on when access to gender-affirming surgeries would begin, despite that the policy change was unanimously recommended by the medical board that oversees VA health offerings.  

Health care for veterans has been a key pillar of the “noble dream” to provide for our nation’s patriots since the Civil War. Over time, health care services for veterans were expanded to meet the needs of an increasingly diverse veteran population and align with improved medical knowledge. More than a century ago, the U.S. government began providing gender-based health care to male veterans but in 1923, it expanded its offerings by accepting women as patients in veterans hospitals. Since then, gendered services have grown to include gynecology and fertility treatment, post-mastectomy needs, abortion in certain cases and, since 2011, gender-affirming hormone therapy.  

Gender-affirming surgery is the logical and moral next step to expand health offerings from the VA. It will take hard work and political courage, but the payoff will be measured in lives saved. 

Transgender veterans face challenges that their cisgender peers do not, including discrimination and violence that can impede daily life. Independent research has shown that while “transgender adults serve in the U.S. military at two to three times the rate of the general adult population … transgender veterans die by suicide at twice the rate of their cisgender veteran peers and approximately 5.85 times the rate of the general population.” Additional research shows that there’s a significant decrease in suicidality for transgender people who obtain the medically necessary care.  

The VA health system is already one of the largest medical providers in the U.S. for transgender people. To fulfill its mission of caring for those who served in our nation’s military — as well as their families, caregivers and survivors — the VA should provide the full spectrum of medically necessary, life-saving care to all patriots who served in uniform.  

I understand what it feels like to fight for freedoms that I, myself, could not even enjoy — a pain shared by my transgender constituents and thousands of their peers across the nation. What better way to honor the service of transgender military veterans than by giving them the chance to live — to flourish — as their full, authentic selves?  

Anthony Woods is Maryland’s secretary of Veterans Affairs.